Basrah Journal of Surgery

Background: Mandibular fracture is one of the commonest facial skeletal injuries, the classical
treatment for condylar fracture either by close or open reduction. The purpose of this study is to
prove the effectiveness of early functional rehabilitation through the effect of neuromuscular
adaptation in unilateral and bilateral condylar fractures .
Patients and Methods: A prospective study included thirty patients presenting with condylar
fractures, divided into three age groups , group I children less than 12 years old , group II teenagers
age range 12-17 years old and group III adult more than 17 years those admitted to maxillofacial
department in Al-Basra Teaching Hospital from May,1,2015 until October,30,2016 presented with
a malocclusion, a deviated midline, and a limited mouth opening. Computed Tomography is done
as early as possible. The method used in our study was the early closed active functional treatment.
Results: Young patients less than 12 years of age were 17 (56.7%), also we found that the
dislocation of condylar head fracture was more common in the very young age group according
to the CT- Scan. Teenagers patients (12-17) years of age were 2 (6.7%) while adult patients more
than 17 years old were 11 (36.7%) .
Conclusion: The complete condylar remodeling (restitution of condylar head) occurs in very
young age group (less than 12 years old) and to less extent in others age groups , the diagnosis
depend on ct scan findings in pre and post imaging

The aim of this study: To assess the efficacy of advanced platelet-rich fibrin (A-PRF) and 1% hyaluronic acid gel
(HA ) as a regenerative biomaterial for wound healing after impacted third molar extractions.
Materials and methods: This study was a randomized controlled trial carried out in the oral surgery unit of the dental
teaching hospital. Furthermore, the participants were randomly assigned into three different groups. The patient's
surgical site was left without adding any material in group A. While in group B (study group), the patient's surgical
site was treated by applying a mixture of 1 cc HA gel with a one gel foam sponge. In group C (study group), the
surgical site was treated by placing an A-PRF clot inside the surgical site. The first follow-up visit was 24 hours after
the surgery to assess the soft tissue healing, with subsequent assessment visits on the third and seventh postoperative
days.
Results: Hyaluronic acid and A-PRF groups, when compared with the control group, showed significant improvement
in early wound healing scores. However, the A-PRF group had a statistically significant improvement over the
hyaluronic acid group only during the first and third postoperative days.
Conclusion: Hyaluronic acid gel and A-PRF effectively enhanced early soft tissue healing following the surgical
removal of the impacted lower third molar. with the upper hand for the A-PRF in the 1st and the 3rd postoperative
days disappears in the 7th day.
Thus, the ease of availability of the Hyaluronic acid gel makes it an attractive alternative to the APRF.

Background: The study aims to present the location and course of the posterior superior
alveolar artery (PSAA) using cone beam computed tomography (C.B.C.T.) imaging, which is
considered as a valuable part for treatment planning in sinus augmentation procedures for
dental implant treatment.
Materials and Methods: Data was extracted from included C.B.C.T. images using implant
planning software and entered on Microsoft Excel and SPSS for statistical analysis. For each
radiograph measurements were taken on premolar and molar region to determine the location
of PSAA as being extraosseous or intraosseous. The distance of the artery from the floor of the
sinus was also measured.
Results: The study included 56 radiographic images. 44 view of right and left maxillary sinus
satisfied the inclusion criteria. Each sinus had 2 points of measurements, giving total of 176
sites. The average distance of PSAA was 11.1 from the floor of the maxillary sinus and the
median was 10.5mm. The PSAA was extraosseous in most instances with 57% of the total
sample.
Conclusions: The location of the PSAA can be mostly in extraosseous site. The artery might
also move from extraosseous to intraosseous location, or Vise versa, during its course as it
travel from the molar to premolar area. Correct identification during planning of sinus lift
procedures can help in avoiding accidental trauma during surgery

Background: Infection is one of the major complications in endourological procedures, and
may range in severity from mild fever to septic shock. A survey on postoperative antibiotic
usage showed varied usage. No clear guidelines exist for the same.
The objective of this study is to rationalise the usage of post-operative antibiotics in urine
culture negative patients with symptomatic upper urinary tract calculi.
Materials and Methods: A prospective randomised controlled study done from March 2021
to February 2022. A total of 250 cases operated for upper urinary tract calculi at our institution
with sterile urine culture are considered. All the patients received only single dose of
prophylactic antibiotic before surgery and no postoperative antibiotics were given. They were
divided into 2 groups to assess the local antibiotic (gentamycin) implications in reducing the
usage of post-operative antibiotics. Postoperatively fever was assessed along with other signs
of infection like pyelonephritis, symptomatic urinary tract infection (UTI) and sepsis.
Statistical analysis is done and p value <0.05 is considered significant.
Results: A total of 19 patients (8%) developed fever among 250 patients. Among the 124
Percutaneous Nephrolithotomy (PCNL) patients, 11 developed fever and among 126
Ureterorenoscopic lithotripsy (URSL) patients, 8 developed fever. Overall fever incidence is
similar with gentamycin (7.5%) or standard normal saline (NS) irrigation (7.7%). None of the
patients developed pyelonephritis, UTI or sepsis.
Conclusion: Single dose of pre-operative intravenous (IV) antibiotic is sufficient for upper
tract urolithiasis procedures. There is no significant role of local antibiotic instillation in
irrigation fluid, on the post-operative infections.

Abstract
Background: COVID-19 infection has been implicated in millions of deaths worldwide. The
respiratory distress occurs with cytokine storm around 2ndweek of symptom onset.
Tocilizumab, a humanized monoclonal antibody directed against the interleukin 6(IL-6)
receptor has been used at varying extents in suppressing it, however, limited literature exists
about the timing of its administration. We contemplated this study with the primary objective
to establish whether tocilizumab favourably affected the outcome when given in the early
stages of complication. The secondary objectives were to assess the importance of ROX score
and the effect of age on outcome.
Methods: We conducted a retrospective study in a tertiary care hospital. Patients who
received tocilizumab were divided into two groups depending on whether they received the
drug in ≤ 10 days (Group 1) or≥ 11 days (Group 2) of onset of symptoms. The patient’s
demographic data and co-morbidities, on- admission vitals, ROX score, and laboratory
parameters, outcome etc. were collected from the electronic health records.
Results: Both groups were comparable with regard to demographic and baseline parameters
on admission. The outcome was significantly better in patients of Group-1(P=0.01) with
better survival. The outcome was also significantly higher in ages ≤ 50yrs age(P=0.02) who
received tocilizumab. Failure to improve ROX score after 24hrs. of administration of
tocilizumab was associated with poor outcomes (p=0.001).
Conclusion: Tocilizumab when given in the early stages of COVID-19-related complications
may be associated with decreasing mortality. Age may be an indicator of favourable effect,
and failure to improve ROX score after tocilizumab is associated with poor outcomes

Background: Periodontitis is universally agreed to be an inflammatory disorder which arises as a
consequence of periodontal pathogens interacting with the host’s immune response. A significant and
crucial element in the onset and advancement of periodontitis is oxidative stress. 8-OHdG is a molecule
that’s considered a significant biomarker of oxidative stress.
Aim of the study: Analyzing the salivary levels of 8-OHdG in patients with periodontitis/obesity in
comparison to healthy controls with analysis of its correlation with various clinical periodontal parameters.
Materials and methods: 110 subjects (30 obese, 30 periodontitis, 30 obese periodontitis and 20 healthy
subjects) took part in this study. Samples of saliva were acquired from all subjects before clinical
examination. Full periodontal examination was conducted for each participant which entailed plaque index
PLI, bleeding on probing BOP, probing pocket depth PPD and clinical attachment loss CAL. We assessed
obesity utilizing body mass index BMI.
Results: It was showed that periodontitis patients and obese patients had significantly elevated
concentrations of salivary 8-OHdG when compared with healthy subjects. Also these levels correlated
positively with CAL in obese periodontitis patients.
Conclusions: This study revealed an association between 8-OHdG and periodontitis which implies that this
biomarker serves a vital part in the periodontal disease process. Moreover, this study showed an association
between this biomarker and obesity measures, which suggests that periodontitis and obesity are
interconnected via oxidative stress

ABSTRACT
BACKGROUND: Female urethral strictures are infrequent, which explains why the literature on female
urethral stricture therapies is scarce. We present the results and complications of dorsal buccal mucosa
graft urethroplasty in female patients with urethral stricture.
METHODS: Between January 2017 and December 2019, 25 women aged 33 to 65 with urethral stricture
disease underwent urethral restoration with a dorsal onlay buccal mucosa transplant. Uroflowmetry (Q
max) and micturating cystourethrography were used to diagnose patients. To rule out bladder pathology,
a urodynamic examination was performed. Following catheter removal, UFR was performed every three
months for one year, then every six months. RESULTS: The average age of the paƟents was 52.48 years. A
stricture's average length was 1.9 cm. Before and aŌer surgery, the mean Q max was 6.7 ml/s and 19.6
ml/s, respectively. The majority of UFR patients following catheter removal had a Q max of more than
15ml/hr. After three months of catheter removal, three patients complained of inadequate flow, which
was dealt with with urethral dilation twice a week, and their strictures were resolved after six months.
CONCLUSION: The dorsal technique with buccal mucosa transfer allowed us to successfully restore an
appropriate urethra in females

Background: Papillary thyroid carcinoma is the most common endocrine and thyroid
malignancy. The (BRAF V600E) mutation is the most common mutation in papillary thyroid
cancer (PTC). The mutation is detected in about (60%) of the cases.
Patients with BRAF mutation have been linked to aggressive clinical behavior, high
recurrence rate, metastasis, and failure of treatment
Aim of the study This study aims to find whether Immunohistochemisrty can
substitute molecular analysis in detection of BRAF V600E mutation in papillary
thyroid carcinoma. This will safely time, cost, and effort.
Patients and method This was a retrospective study, carried out in Basrah province,
wax blocks were collected from histopathology labs during period from October
through September 2023. Tissue sections were obtained from the paraffin blocks and
submitted to routine hematoxylin and eosin stain. Then Immunohistochemical
staining using primary monoclonal antibody for detection of BRAF mutation in
papillary thyroid carcinoma.
After examination of H &E slides, the area of papillary thyroid carcinoma was
determined and Then piece of tumor tissue with thickness of 5~10 um and a surface
area between 0.5~1 cm². was taken from the wax block for DNA extraction and
detection of BRAF mutation using Real-time PCR.
Darweesh, S., Al-Diab, J., Al-Harron, S., Hasson, H. Comparative study between Im

Background: Appendicitis is a common surgical emergency with a global incidence of
approximately 233 per 100,000 population. The incidence is higher in males than in females, and
it varies across seasons and countries.
This study aims to throw light on the pattern of appendicitis in Basrah. Iraq
Methods: This is a retrospective analysis of all available data in Basrah Teaching Hospital for the
last 10 years covering the period from January 1999 to December 2008. The total number of
hospital admissions for each year was obtained in addition to age, gender and month of admission
for all the cases of appendicitis were recorded. Tables and figures were drawn and an analysis was
done, using simple Chi square test, and P value as found appropriate.
Results: There were 5412 patient underwent Appendectomy with M: F ratio as 3.4: 1. The overall
mean age was 24.3 years. The highest incidence was in April, May, June, and July with a peak
level in December. Ramadan (the fasting month) showed a significant increase in incidence of
appendicitis
Conclusion: There is an increase incidence of acute appendicitis over the years with more
prevalence in males and more common in the second decade of life for both males and females,
also the incidence was higher in summer moths and in Ramadan

Background: The most powerful independent prognostic variables were GCS (Glasgow Coma
Scale) and CT characteristics. Since the introduction of CT imaging, the treatment of patients with
head injury has improved considerably and it has become a powerful prognostic tool for improving
clinical care in TBI (Traumatic Brain Injury), significantly reducing both morbidity and mortality.
Aim of study: To assess the validity of Glasgow Coma Scale and brain computed tomography
scan together in predicting outcome of patients presented with traumatic brain injury at emergency
department.
Patients and methods: A prospective follow up study carried out in Emergency Department of
Baghdad Teaching Hospital in Baghdad Medical city for period from 1st of October, 2015 to 30th
of September, 2016 on convenient sample of 244 patients with traumatic brain injury. The
diagnosis of traumatic brain injury was based on New Orleans Criteria and Canadian Diagnostic
Rules and confirmed by Neurosurgery physician. Glasgow coma scale was measured by researcher
and interpretation of Glasgow coma scale was done by both researcher and Neurosurgery physician
according to Glasgow Coma Score and computerized tomography scan was interpreted by
Radiologist.
Results: The validity results of Glasgow coma scale regarding traumatic brain injury patients'
outcome were sensitivity (100%) and specificity (58.9%), while validity results of computerized
tomography scan findings regarding traumatic brain injury patients' outcome were sensitivity
(66.6%) and specificity (93.6%). The validity results of Glasgow coma scale findings regarding
traumatic brain injury patients' morbidity were sensitivity (70.5%) and specificity (99%), while
validity results of computerized tomography scan findings regarding traumatic brain injury
patients' morbidity were sensitivity (77.7%) and specificity (99%).
Conclusions: The use of both Glasgow coma scale and computerized tomography scan emergency
department had valuable results in prediction of morbidity for patients with traumatic brain injury
while have no effect for prediction of mortality.

Background: Lichtenstein in the 1980, employed a mesh piece to the inguinal canal`s floor. It
showed superior results compared to previous tissue-based repairs. It is gold standard for open
hernia repair with recurrence rate at 5 years <4%, with risk of severe chronic pain at 3 years =
6%. The Chastan technique, in 2005, was developed to improve the Lichtenstein technique. He
was using different dissection and different mesh implantation (small grips covering whole of
one side of mesh to secure immediate fixation around the cord with a self-gripping flap). Here in
Basrah in 2016, we try to improve the Lichtenstein technique by using the same dissection of
Chastan but differ from Chastan in applying of mesh. We used polypropylene mesh in three
techniques.
Aims: A comparative assessment of operative time, early and late postoperative complications of
surgery for inguinal hernia repair using lichteinstien, Chastan and Basrah techniques.
Methods:Between December 2016 and December 2019, a total of 150 male adult patients with
primary inguinal hernia were included according to inclusion criteria of our study. Patients were
divided into 3 groups each group contain 50 patients which undergo Lichteinstien (L), Chastan(C)
and Basrah(B) techniques respectively: All patients followed up to two years. The operative time,
early and late postoperative complication were compared among three groups.
Result: The 3 groups were similar in terms of age, sex, comorbidities, BMI, ASA classification,
types of inguinal hernia (Nyhus classification). There is no significate difference in terms of
operative time (p value=0.954),24-h VAS score, length of hospital stays (LOS) and return to work
(RTW), (p value=0.607,0.206,0.651 respectively). Seroma formation, chronic pain and recurrence
rate were lower in Basrah and Chastan than Lichtenstein

Background: This study evaluated the accuracy of the Score: renal stone density, inferior
pole stone, renal infundibular length, stone burden (R.I.R.S) scoring system (kidney stone
density, inferior pole stones, stone burden, and renal infundibular length) in predicting the
stone-free rate (SFR) post RIRS. Methods: This retrospective study was conducted in 50
patients aged 18-65 years undergoing RIRS for kidney stones in a tertiary institute hospital
from February 2022 to June 2023. Medical records were analysed to obtain the the preoperative investigations, intra-operative findings and post-operative complications and follow
up data. The RIRS parameters were also measured to predict stone free rate post RIRS.
Results: 38% patients had mild RIRS score (4-5), 60% patients had moderate RIRS score (6-
8) and 2% patients had severe RIRS score (9-10). 46 patients (92%) had stone free (SF) status
while remaining 4 patients (8%) had residual stone fragments. 22% patients had
complications such as fever (18% patients) and urosepsis (4% patients). AUROC for stone
burden (mm) and stone density (HU) predicting SF status was 0.989 (p = 0.001) and 0.837
(p = 0.028) respectively. AUROC) for R.I.R.S. Score predicting Complications was 0.8 (p =
0.002) statistically significant. Conclusion: R.I.R.S. scoring system was statistically significant in assessing stone free rate and complications. The higher R.I.R.S. score was
associated with more residual stone fragments, lower stone clearance and higher postop
complications. Hence R.I.R.S is a reliable and accurate preoperative tool for estimating the
probability of stone-free state and complications after RIRS surgery